Healthcare In Crisis

Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I want to talk about my personal experience with nursing and the healthcare crisis. I have talked about this before, but I feel that the Tik Tok that I have linked above has covered much of what I have been trying to convey in a much better manner then I ever have managed.

There is no way to over stress how damaging the burn out in the nursing field is. All too many consider this to be a personal failing rather then a systemic failing. When the majority (95%) of a group is experiencing something it is unlikely that it is because of a personal failing. Despite the nursing profession yelling from the rooftops about how dangerous things are getting, nothing is being done.

We are being held to an impossible standard with a catch 22 of expectations. I have reached the point that I am no longer capable of giving my patients the compassion that the deserve. When I talked about being burned out and needing support I heard nothing useful. Mostly I was told that if I could not handle the profession, I needed to leave. So, I did. It’s been 2 weeks that I have not been at the bedside. And now I am being told that I am part of the problem because there are not enough nurses and no one wants to work.

I have been a nurse for 20 years. And you want to know what is true about my experience over those 20 years? I worked 60-80 hours a week for most of my career. This was because I wasn’t making enough money to support my family on a 40 hour week. It was because there were never enough nurses to cover the shifts. It was because I felt guilty about leaving my coworkers short staffed. So, I think it is fair to say that I am a person who is willing to work. In all of the 20 years I have worked, there wasn’t a single shift that I was working at the bedside that I did not experience some form of verbal, physical or sexual abuse from my patients or coworkers. That’s right. Every shift at the bedside was abusive.

That physical abuse has included slapping, pinching, scratching, kicking, shoving, biting, spitting on me and punching. That emotional abuse has included yelling, swearing, name calling, threatening and accusations. That sexual abuse has included grabbing of my breasts, patting or grabbing of my butt, people putting their hands beneath my clothing, making comments about the sexual things that they would like to do to me, threatening to sexually assault me and making comments about my physical appearance. Every shift that I have worked I experienced some combination of these abuses against my person. Every shift. This is not an exaggeration.

In addition to these abuses, nurses are also being neglected. We are denied being allowed to attend to our basic human needs such as having a chance to void our bladders, evacuate our bowels, eat food or drink fluids. This is for the duration of 12 or 16 hour shifts which we are not allowed a single break. For half the day or more, we are not allowed to attend to any of our own basic human needs while we are being expected to attend to the well being of others.

The state of Maine defines chronic abuse or chronic sexual abuse as recurring acts of physical abuse that place the person’s health, safety and well-being at risk. The conditions that nurses are expected to work in on a daily basis are the conditions that the state has defined that custody or guardianship should be revoked. People can go to jail for treating people under their care in the manner that nurses are being treated while they are working (and rightly so). If I treated my patients the way that I was treated as a bed side nurse I would have lost my license and gone to jail for abuse and neglect. Yet, I am expected to work within those same conditions without complaint while still providing high quality health care to others.

When a person faces conditions of chronic abuse, their risk for developing PTSD are rather high. Nurses experience a higher rate of PTSD now then those who have fought in wars. About 50% ICU and ED of nurses are currently in a state of PTSD. The rate is only about 15% for those who have gone to war. [1], [2] This is absolute insanity. Yet, when we complain that the working conditions are not safe and are not healthy, we are told that we need better coping skills and that it is a personal failing that has lead us to feeling burned out. Go ahead and google nurse burnout and see what comes up.

But let’s talk about what nursing burn out actually is, because it is a phrase that is often used without an exploration of the meaning. “Burnout includes 3 key aspects:

  • Emotional Exhaustion (EE): the state of being physically and emotionally exhausted by work stress, which is characterized by low energy, fatigue, depression, hopelessness, and helplessness.
  • Depersonalization (DP): the interpersonal aspect of burnout that manifests in unfeeling, negative behaviors toward others, and detachment from caring and instructions.
  • Low Personal Accomplishment (PA): the state of negatively evaluating ones’ self as being incompetent, unsuccessful, and inadequate; consequently, employees exhibit low levels of contribution to their work.” [3]

Depersonalization is the one the list that gets most of the attention and rightly so. It is this symptom that is leading nurses to on much unprofessional behavior such as making fun of their patients and dismissing the needs of their patients. How can a nurse possibly provide high quality care when they are in a state of depersonalization? The answer is that they can’t. It is simply not possible. This comes back down to Maslow’s Hierarchy of Needs. When the foundation of needs is not being met, a person cannot reach other, higher, states of being. It literally forces the person into a state of fighting for their survival.

Looking at this pyramid of needs, one can see the foundation of needs are the physiological needs such as food, water, warmth and rest. These are things that are being denied nurses while they nurse long shifts. The second tier of needs is the need for safety which is also being denied nurses. Working in a constantly abusive environment denies the possibility of a nurse ever feeling safe while they are working. The principles of psychology teach us that until these two needs are being met, a person is INCAPABLE of reaching a state where they can have healthy and appropriate relationships. These first two tiers are considered the BASIC NEEDS because a person can achieve nothing else when this foundation is lacking. [4]

When looking at the treatment guidelines for PTSD, the first thing that must be done is that the victim of the abusive or traumatic situation must be removed from the situation. A person cannot recover from trauma when they are existing in the conditions that caused their trauma. [14], [15] This means that there is no amount of self care or coping skills that a nurse can engage in to recover and continue to work. Both the civilian and military disability systems recognize PTSD as a disorder that is disabling because it causes disturbances in behavior and creates an inability to appropriately interact with others. [16], [17]

What I find most frustrating about all of this is that as a chronic illness patient, I have been experiencing the dismissal of my medical symptoms and personal experience my entire life. Thus, the one group that I thought would be willing to hear me out and validate my trauma experience as a nurse was the chronic illness community. Instead, my experience has been that the chronic illness community is completely unable to see me as anything but the villain in their personal drama. I understand that healthcare providers, including nurses, have been treating chronic illness patients badly for years now. What I am telling you is that they are doing it because of a trauma response. Not addressing that trauma is going to result in a worsening of healthcare and a worsening treatment for chronic illness patients.

The victim blaming needs to stop. My nursing related PTSD has rendered me unfit to provide care and I am in a stable enough position right now that I can afford to leave bedside nursing. Not every nurse can afford to leave their jobs since their income is supporting their families. A nurse shouldn’t have to leave their family without income in order to get the trauma care they need and deserve. Yet that’s where we are at right now. Because of this, many nurses are choosing to continue to work as nurses long past the time that they should have left the field. Additionally, if every nurse that is experiencing PTSD left the field right now in order to get the trauma care they need, there would be no nurses left to provide the care.

For the sake of everyone, we need to come together and recognize the needs of everyone. As long as patients and the community as a whole are unable to see nurses as being people in a mental health crisis, there will be no improvements in health care. And this current trajectory is not sustainable. We can no longer afford to blame individuals for a systemic problems that are causing abusive and neglectful working conditions. While I am speaking from the perspective of a nurse, because that is the field that I have been working in, it is important to note that these problems are not isolated to nursing alone. Research reflects that most healthcare workers are also experiencing burnout and PTSD. [8] The current American model of putting the benefits of corporate gain above taking care of the citizens is damaging on all levels, even within our healthcare system. Until we address the reality that a for profit health care model does not work, we will fail to solve the crisis that is threatening to collapse our healthcare system completely.

What is true about the American healthcare system is that we are horribly failing to provide our patients quality care as compared to the care being provided by other countries[18], we are spending more on our healthcare then any other nation in the world [19] and we are destroying the possibility of recovering from these failures by disabling the workers who are responsible for providing that care [5], [17]. In all of these aspects, the problem stems from the reality that our healthcare is a for profit system where the patient’s health and well being is a secondary goal to the hospital making a profit. This reality is at the heart of the nursing shortages and the moral injuries that are driving much of the PTSD in nurses.

Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like what you read, click on that like button. It really does help! Until we talk again, you take care of yourselves!

Additional Reading and References

  1. How Common is PTSD in Veterans?
  2. PTSD in Frontline Healthcare Workers
  3. Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits
  4. Maslow’s Hierarchy of Needs
  5. Post-traumatic stress disorder in nurses: An integrative review
  6. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses
  7. Are incivility and pandemic denial from unruly patients the new normal?
  8. The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders
  9. The independent predictive value of peritraumatic dissociation for PTSD symptomatology after type I trauma: A systematic review of prospective studies
  10. Anger, dissociation, and PTSD among male veterans entering into PTSD treatment
  11. Dissociation and posttraumatic stress disorder in Vietnam combat veterans.
  12. Exploring the Roles of Emotional Numbing, Depression, and Dissociation in PTSD
  13. Dissociation in posttraumatic stress disorder part I: Definitions and review of research.
  14. Treatment Guidelines for PTSD: A Systematic Review
  15. VA practice patterns and practice guidelines for treating posttraumatic stress disorder
  16. VA Disability Rating for PTSD: Criteria, Eligibility, and Making a Strong Disability Claim 
  17. Disability Evaluation Under Social Security
  18. Organization for Economic Co-operation and Development Database
  19. Per capita health expenditure in selected countries in 2020

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